St. Francis Critical Care:
Nursing Unit Assessment
Kayla Hopper, Kerri Jo McDaniel, Alex Rodriguez, Baylee Stephens,
Kailey Sweatman, & Sam Trupp
St. Francis
• Located in Columbus, Georgia
• Nursing Manager: Kelli Koelsch
• Intensive care unit (ICU)- 13 beds
• Critical care unit (CCU)- 11 beds
• Overflow care unit (OCU)- 4 beds
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Who is Kelli Koelsch?
• Nursing manager for both the CCU and ICU units at St. Francis
hospital
• Worked bedside for 12 years
• Has been a nurse manager for 2 years
• Advice:
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Know how to multi-task
Always identify communication as a problem
People skills are a must
Have to be able to admit that you are wrong
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Mission
St. Francis, a community-owned, Catholic healing ministry exists
to provide exceptional health care services, in partnership with
physicians, for all those in need.
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Vision
St. Francis will be the preeminent health care delivery system in
the Chattahoochee Valley and surrounding communities- the
first choice of patients, physicians, associates and payers for
health, wellness and life.
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Core Values/Goals
• Excellence
• Professionalism
• Courage
• Compassion
• Creativity
• Open Communication
• Mutual Respect
• Ethical Behavior
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Unit Culture
• Good interpersonal relationships
• Friendly with peers, patients, and families
• Teamwork
• Good orientation for new nurses
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Conflict Resolution
Strategy
• Open communication
• Hear both sides of the story before a decision is made
• Address the problem with each person individually
• Have a meeting with all individuals involved
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National Patient
Safety Goals
• Pressure ulcer prevention
• NPSG.14.01.01: Assess and periodically reassess each resident’s
risk for developing a pressure ulcer and take action to address any
identified risks.
• Central line-associated bloodstream infection prevention
(CLABSI)
• NPSG.07.04.01: Implement evidence-based practices to prevent
central line-associated bloodstream infections.
• Catheter-associated urinary tract infections (CAUTI) prevention
• NPSG.07.06.01: Implement evidence-based practices to prevent
indwelling catheter-associated urinary tract infections.
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Pressure Ulcer
Prevention
• Nationwide:
• 2.5 million patients per year acquire a pressure ulcer
• Pressure ulcers cost $9.1-$11.6 billion per year in the U.S.
• About 60,000 patients die as a direct result of a pressure ulcer each
year
• St. Francis Critical Care Unit:
• In the beginning of 2012, the ICU had 2 pressure ulcers and the
CCU had 2 pressure ulcers
• As a result, they reevaluated the policies and procedures
• Purchased new critical care beds
• Set up turn teams on ICU and CCU
• Designate 2 nurses per shift to remind all the other nurses about
positioning
• Chart position every 2 hours 10
Financial Issues on the
Unit
• Core measures and reimbursement complications
• Performance based
• Must score well to be reimbursed for care
• Performance is tracked throughout the year by submitting data.
• If they don’t submit data/score well, they don’t get reimbursed.
• Sample data that is graded
• Post-operative patients have to have their Foley catheter removed by
post-op day 1
• Have a blood sugar less than 200 post-op
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Need for Change on
the Unit
• Change needed: Reporting at the bedside
• It is a standard of nursing practice that report be given at the
bedside.
• Driving force:
• The unit implemented a policy that nurses give report at bedside
(except for some personal patient information).
• Restraining force:
• It is difficult to shift from reporting in the nursing station because it
is a habit.
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Patient-centered Care
• Open visitation policy
• Except for the quiet time at night or during certain procedures
• Visitors can’t stay on the unit over night, but the waiting room is
always open
• Physician explanation
• Physician should make the decision of whether to discuss patientcare and interventions with the family or another group of doctors
if the patient is unable to make their own decision
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Continuous Quality
Improvement Measures
• Hospital-wide measures that are more focused on this unit
• Acute coronary syndrome policy
• Goal: 90 minutes to cath lab
• Stroke
• CT within 3 hours
• TPA if indicated
• CABG
• Prevention of sternal infection
• Ventilator-associated pneumonia
• CAUTIs and CLABSIs
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Leadership Skills
• Focus on interpersonal relationships
• Facilitates feedback to ensure that communication remains open
• 3 staff meetings offered per month for the sake of
communication
• Power of motivation
• Team building
• Consistent feedback
• Discipline policy
• 1st offense: documented, but education on the error is the focus
• 2nd offense: verbal warning
• 3rd offense: write-up
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Current Recruitment and
Retention on the Unit
• Recruitment:
• They do not have any bonuses, referral bonuses, or any huge effort
in place in the CCU
• Recruit within the hospital using the clinical ladder
• Retention/Attrition Rate:
• They do have a retention problem because people go back to school
(nurse practitioner and CRNA schools)
• Average years worked is 5
• Big turnover every 2 years for people going back to school
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Staffing Process
• Normally a 2:1 ratio
• Exceptions to the 2:1 ratio:
• Open heart, balloon pump, induced hypothermia, or if the patient
has coded or is at risk for coding
• All of these would be a 1:1 ratio
• Floating
• Try to avoid calling in other unit nurses because CCU/ICU is so
specialized
• If it is a necessity, they prefer to call nurses from telemetry
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QUESTIONS?
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References
• http://www.ahrq.gov/research/ltc/pressureulcertoolkit/putool
1.htm
• http://www.jointcommission.org/standards_information/jcfaq
details.aspx?StandardsFaqId=163&ProgramId=1
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